"They get a c-section...they gonna die”: Somali women's fears of obstetrical interventions in the United States

Purpose: Since 2000 over 35,000 Somali refugees have resettled in the United States. We explored resettled Somali women's concerns about prenatal/obstetrical healthcare services in the United States and elicited their views on obstetrical interventions. Methods: We conducted interviews with 34 adult Somali women in Rochester NY to explore their beliefs and practices about prenatal care and obstetrical management of labor. We coded and analyzed the transcribed interviews using an approach guided by grounded theory. Results: The average age of the thirty-four participants was twenty-seven years; fifteen (44%) women were Somali Bantu, nineteen (56%) were other Somali (non-Bantu). Ten (29%) women spoke English and did not use a translator. We identified the following key themes: aversion to cesarean sections (75%, n=25), with fear of cesarean sections (64%, n=16), specifically fear of death (56%, n=14) cited as a primary reason for aversion to them. Other prominent themes included resistance to other invasive obstetrical interventions such as induction for post-dates pregnancy, and experiences of time pressure to accept invasive obstetrical interventions. Conclusion: Clinicians should specifically address Somali patients' potential sources of resistance to common US prenatal/obstetrical care practices by eliciting patients' fears about interventions anticipated during labor and delivery, especially if the interventions include plans for induction or cesarean section. Policy implications: Prenatal and obsterical educational programs, developed collaboratively by the Somali community and health care professionals, are a promising means to address resistance to obstetrical interventions and improve quality of care for Somali women.